Stephanie Hepburn

Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .​

People in the south use 988 less than those elsewhere in the US. 

This is one of the findings from a 2025 study published in JAMA on 988 usage, the nationwide number for mental health and suicide crisis that launched in July 2022. The study is part of a five-year National Institute of Mental Health grant to examine 988 implementation with a keen eye toward state financing and its effects on a range of 988 metrics.

“We wanted to take a look at 988 contact volume and state-level variations,” says Jonathan Purtle, an associate professor at the New York University School of Global Public Health.

Purtle and his colleagues examined the contact rate over the past year using data provided by Vibrant Emotional Health, the nonprofit that runs the nationwide 988 Suicide and Crisis Lifeline funded by the Substance Abuse and Mental Health Services Administration, commonly known as SAMHSA. The researchers also looked at contact volume rate since the hotline launched.

“We see a pattern where southern states are using 988 less.” He says this corresponds with public opinion that there’s less inclination among people in conservative states to reach out to 988 and perhaps more skepticism toward the hotline.  

A way to address the gap is through marketing, notes Purtle. Not only through thoughtful messaging to increase awareness of 988 but also by addressing stigma and cultural hurdles. 

The study also found that people throughout the US are 2.24 times more likely to head to the emergency room for a mental health issue than contact 988.

Purtle suggests this illustrates an opportunity for 988 to grow and meet the mental health needs of Americans.

“I don’t think finding that the rate is half of emergency department use is an indicator of anything being wrong with 988; it’s a new service and we see the volume continues to increase.”

The study’s researchers wanted to know if states that passed 988 telecom service fees had higher usage rates than those that hadn’t. 

“That didn’t jump out from the data.”

In 2021, Virginia became the first state to pass 988 service fee legislation. Since then, only 12 states have enacted a 988 fee, though 33 states have made 988 appropriations. A spreadsheet by the National Alliance on Mental Illness, which has been tracking fee legislation, shows service fees range from $.08 to $.72, with most hovering around $.25-$0.40 per line, per month. All are under $1.

Estimated revenue from the service fees ranges from $1 million in Vermont to $55.6 million in California. 

Regionally, 988 usage was highest in the West and Northeast, followed by the Midwest. In the South, 988 use was 36% less than in the West, both in terms of total contacts since July 2022 and in 2024 alone. 

Source: “Use of the 988 Suicide and Crisis Lifeline at National, Regional and State Levels” published in JAMA on June 9, 2025

When the researchers ranked the states from greatest to least 988 usage, the two largest Southern states — Texas and Florida — were both at the bottom.

“These are big states with big population centers in the United States, so that was troubling to see because we want to see national impact and national benefits from 988.”

He believes there’s room for sustained growth of 988 but increasing use will require thoughtful marketing and communications. Similarly, growth can’t happen without expanding the workforce and capacity to answer those contacts.

“That’s going to take funding. The data shows, especially in southern states, there could be some real benefit to increasing funding.”

Purtle and his team plan to take a deeper look at differing state financing approaches on outcomes. They’ll examine 988 metrics, such as wait times, in-state answer rates, contact volume rates and abandonment rates.

“We’ll also be looking at the effects of different financing approaches, especially telecom fees on more downstream outcomes, such as emergency department use for mental health, crisis, self-harm and suicide.”

As more time elapses and states adopt and implement service fees, Purtle says there will be more data to illustrate their effects on access. 

“We have a couple more years to see, at the end of the day, how financing affects these outcomes we care about.”